1063771616 NPI number — SOUTHEASTERN CATARACT LASER CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063771616 NPI number — SOUTHEASTERN CATARACT LASER CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN CATARACT LASER CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063771616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27438-8157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-282-5000
Provider Business Mailing Address Fax Number:
336-482-3778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3312 BATTLEGROUND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27410-2548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-282-5000
Provider Business Practice Location Address Fax Number:
336-482-3778
Provider Enumeration Date:
05/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
EPES
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
MEMBER/ORGANIZER
Authorized Official Telephone Number:
336-282-5000

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  183985 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com